Provider First Line Business Practice Location Address:
1447 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-823-4247
Provider Business Practice Location Address Fax Number:
410-823-4248
Provider Enumeration Date:
12/28/2009